Smaller agencies

Therhapsody89 · Dec 4, 2015

Having traveled with a very large company and a few smaller ones, the smaller ones paid better and the recruiters were more personable and helpful, IN MY OPINION. My mother also travels and her best experiences, pay and like of the company, were with hospitals that hired travelers themselves without going through the middle man. My favorite so far has been Sunbelt Staffing. My mom's favorite is Banner Health. I'm currently with Nurses Rx, a company owned by AMN and while my experience hasn't been awful, I will most likely go back to Sunbelt. I think your experience is mostly based on your recruiter. Good luck!!!

ryanstum15 · Dec 4, 2015

Ok thanks for the advice. I also recently asked a question on the travel nursing thread about meals and incidentals and housing amounts. I'm told to go to GSA.gov and find the amount that way. For example, if you add up the total for Nashville,TN , the amount weekly for housing and meals is around 1300-1400$ per week. But, it seems every company I have ran into definitely offers no where near that in tax free money. Is it common for companies to not offer anywhere near the GSA maximum amount or do the better companies give you full amount? I've heard of a couple of companies giving you lower hourly but the full GSA tax free amount and would prefer this tax free money over the hourly, just my opinion.

Thanks again for the advice.

NedRN · Dec 4, 2015

Smaller agencies have lower overhead and so have a bigger portion of the bill rate they can pay to travelers. Less marketing (depending more on word of mouth) is just part of that smaller overhead. Bigger agencies need oversight (extra management) on bigger operations including recruiter managers, accountants, benefits person, lawyer, tax attorney, and a nurse (very expensive) to manage clinical risk. You mentioned GSA allowable reimbursements. You are much more likely to get that full amount from a smaller agency which means their effective net pay will always be better than larger agencies even with the same gross profit requirement (which will almost always be less for smaller agencies as well). The reason for this is rather technical but has to do with tax risk increasing for larger agencies. They cannot afford a possible liability on their SEC filings as their stock would lose value. This is a risk for agencies, not travelers. So smaller agencies have a number of advantages that generally result in higher pay (have to have higher pay to compete successfully against larger agencies).

There are almost 400 agencies (some primarily local per diem agencies) that regularly have travel contracts available. Probably the largest 10 or 20 agencies supply 80% of the travelers. Networking is one way to find them (just as you are attempting to do now) as word of mouth is often how you find them. Yet most of the posts on social media of course come from travelers who use agencies everyone has heard of. So you can focus on agency names you have never heard before and call them to learn the scoop. Remember that I routinely suggest calling a dozen or more agencies, so this is just part of the filtering process for you.

For myself, when I bailed from Cross Country (my first agency), I tended to seek out local agencies in places I wanted to go. Local agencies have a home court advantage, personal relationships with many local hospitals and even department managers, and know their market well. I worked for a Seattle based agency called The Surgical Staff immediately following CC when the assignment I was on went south. I did a number of assignments for First Assist, a DC area registry based in Bethesda, in the DC area and the NE. Paid really well I thought (this was 15 years ago). I worked several times for a now defunct agency that just handled 3 counties north of San Francisco. Had great success with a really new agency (had to help them with basics) called Hospital Support out of Texas now merged with some other agency and the original owner is gone. Several other agencies I worked for just once including the historical early agency Flying Nurses (which changed ownership several times and the name finally went away when MSN acquired them - now owned by Cross Country).

One agency name that has a lot of buzz is Medical Staffing Solutions Inc of Wisconsin (the larger same named agency is also an excellent larger agency that is nurse owned). They have a cultural aversion against using the now ubiquitous vendor managers so their assignment selection is dramatically limited. Lots of hospitals in the Wisconsin area, some in California, some in Texas. Call and ask to be put on their mailing list for open positions. I think they have received so much buzz that they are now growing rapidly. They are pretty much the kind of agency you should be looking for though. I did do one assignment with them about 8 years ago.

I'm not much into Facebook, but there is a page called something like premium travel nurse that is supposed to be restricted to just high paying assignments over $40 (plus the usual). I actually found an assignment there. That one and MSSI are the only ones I have ever found on social media. The rest of them was just keeping my ears open and snooping around. Often I see open assignments on large agency sites for ideas and go from there. I've even cold called hospitals (the specific department) without knowing if they had openings with success (the best being someone about to go out on OB leave and not even sent to an agency). That is too much work usually though unless (like me) it was the only suitable hospital in a given area.

One thing you might be interested in knowing are career stages of a typical travel nurse. Highly variable of course. Start off with a large agency. Lots of assignments, start with an easier one with provided housing and work your way up. Sticking with one agency usually results in higher pay for a couple of reasons: you are a proven traveler and can be trusted with important and better paying assignments, you are a proven traveler and worth more to retain your productivity, and you represent less risk than a new traveler, or even a new to them traveler.

Staying with one agency can last a career, even with a smaller agency. Usually at some point (unless you are really an outstanding traveler with both clinical and people (peer) skills), there will be some issue that may end that relationship (as it did for me after almost four years with Cross Country).

Next comes effectively commoditizing agencies and freely switching. You know your value as a traveler and can negotiate effectively with any sized agency to make sure you always maximize net pay.

That can last a long time (about 6 years for me), and can either stay agency hopping, or start a long term relationship with one or more agencies (which I also did per description above).

Finally, the most advanced stage is cutting out agencies altogether - a baby step towards this is subcontracting with an agency by being a 1099 employee versus the regular W-2 employee. That means effectively forming your own agency to cut out the middleman. I did that a dozen years ago and similar to the jump from staff to travel nursing, it is big jump financially but difficult to enumerate. You now get the gross profit margin of the agency (about 23% of the bill rate on average), but you are also negotiating for just one traveler, yourself. You don't care about having an average bill rate because you don't care to send other nurses to that hospital, just you. Typically I have the best bill rate and terms of any agency at any given hospital because I'm only marketing one profile.

This obviously would be unworkable if every nurse in the country opted out of regular employment and became independent. Nor does is suit most workers for multiple reasons and I don't recommend it particularly. So it is a fringe business, however there are a good number of travelers who do the same (fringe method in a fringe vocation). I even know of two (I assume with prior business experience) who started their first travel assignment as independents. I can't even imagine how difficult that would be without prior travel experience to learn the business from the ground up.

Of course, ordinary agencies come into being by only one of two paths (usually). One way is by a traveler or per diem nurse (or other healthcare worker) starting up (often as I have by contracting themselves out). Lots of nurse owned business out there, and even very large ones often have a nurse involved in the startup (that includes American Mobile, the largest agency). It is interesting how many agencies have been started by OR personnel. I've seen conjecture that it is because we (I'm an OR nurse) have been exposed to business practices much more than other specialties with company reps (many of whom are independent contractors) constantly in the OR to support or sell products.

The more common way for agencies to start is for an agency staffer (such as a recruiter) to decide they can do better on their own and start a new agency. Easier for them because they had direct access to the inner workings of the business and relationships with travelers and hospitals (both of which are necessary to have a viable business) and important now, relationships with vendor managers to have fast access to large number of assignments.

So I've rambled quite a bit, but perhaps I have given you some ideas. Unfortunately, there is no substitute for footwork and elbow grease. You are just not going to find on the internet a list of the 15 best smaller (or best paying) agencies. Do a couple travel assignments and the path will become clearer to you.

NedRN · Dec 4, 2015

OK, just one more thing about maximizing pay (which is really what you want to know). If you do manage to find an assignment on your own, and talk to the manager on your own (pretending to inquire about open travel assignments that you know are there) and effectively interviewing successfully - be prepared to summarize your experience in 60 seconds and also have your profile (resume or work history, skills checklist, and two written references) ready to email. Now you can demand and get top dollar (of course you need to know what that is) and shop different agencies from a position of strength. If the time frame is long enough, that will help an agency who doesn't have the facility or VM relationship, establish it. That is worth even more. But even to an agency with an existing contractual relationship, they have to compete with other agencies for that same assignment. You have it guaranteed so that is worth more than a maybe (a lot more).

It should be clear that using this method (somewhat advanced) and doing the work of finding your own housing (which I did assignment 2 long before the internet and tax advantage started helping and pushing travelers more broadly to do that), suddenly it is like, what value is the agency adding to this? Might as well contract directly!

I am that I am · Dec 7, 2015

Long read but worth every word